— 降低風險 · EASY · MCQ —
一位有跌倒史的病人，哪種預防跌倒的策略最有效？
A nurse is caring for a client with a history of falls. Which strategy is most effective to reduce risk?
- AAsking the patient to refrain from getting up要求病人避免起身
- BKeeping the room dark for rest保持房間昏暗以利休息
- CPlacing the bed in the lowest position✓ 正解將病床調整至最低位置
- DRestraining the patient in bed將病人約束在床上
— Explanation · 中文詳解 —
預防跌倒（Fall Prevention）是 NCLEX 的常考重點，核心原則是「環境安全」與「減少傷害」。當病人有跌倒史，將病床維持在最低位置（Lowest position）可縮短若不慎跌落時的墜落距離，直接降低受傷嚴重度。此外，護理師需評估病人跌倒風險分級（如 Morse Fall Scale），採取如床邊警鈴、夜燈、移除障礙物等措施，而非限制病人的基本活動權利。
Placing the bed in the lowest position is the most effective strategy to reduce the severity of injury if a fall occurs, aligning with fall prevention principles. Restraining patients or restricting movement is generally avoided as it can increase agitation and does not address the root cause of fall risk.